Let me start out by saying this is a little long winded, but it has been weighing on me and I have to get it off my chest, so bear with me!!!
So, my last shift, I had gotten report on a male patient... Read More

Yes, giving him the cup of coffee crossed my mind as a possibility. But, in the moment, the way he was treating me and everyone else (including our brand new, nervous little 19 year old tech), made me want to do everything but give him the coffee. I was mad and angry at how he was treating me. Again, looking back on it maybe I should have just given it to him-but could that have made him stay longer in the day, and then I would have had to deal with him even longer?

Any patient has the right to refuse a doctor's prescribed treatment. YOU had no right to refuse the patient's request. It's a hospital, not a jail.

"but could that have made him stay longer in the day, and then I would have had to deal with him even longer?"

This is not about you, it's about the patient. You basically bounced out a patient that was not ready to go home, that even rescinded his own discharge and was visibly too weak to manage his own care... because your feelings were hurt.

We are trained not to bring patients P.O. anything without talking to the primary nurse, so those responses were correct. I am surprised at the replies to just give him the coffee, but yeah. Probably the right thing to do along with explicit documentation of education and I&Os. His behavior was abhorrent and would be difficult to cope with so give yourself some slack while at the same time thinking how you would do it next time.

The answer above about malpractice insurance is a bit over the top. You had an order to discharge, MD fully aware of the situation to the point of bringing him coffee herself and discontinuing drip and foley.

Next time I would just advise leaning into the situation instead of away. Bring the coffee or facilitate him getting it himself, document the n
Heck out of education throughout the shift and keep strict I&O measured and explicit documentation on behavior. Coach other team members to facilitate his wishes but keep fluid chart where he can see it (white board) along with statement written in simple terms of the pathophysiology of his condition - excess fluid =lung congestion =trouble breathing =hospital.

Sep 21, '17

I probably would have brought him the coffee in a cup with "R.I.P." written on it in sharpie.

When I worked MedSurg, we weren't "allowed" to go over a patient's restriction.

Yep, us too. If the patient is unable to get up and get his own drink, then he's on a fluid restriction, tough cookies. If the doctor wants to lift the fluid restriction, then she can. But I can't.

If the doctor had already put in the order for the discharge, then that patient is going unless the doctor puts in a new order to admit. If the patient wants to sue because he wasn't allowed to change his mind, that's not your problem.

We had a patient situation sort of like this - patient signed out AMA and then changed his mind (after only being on the floor a few hours) The hospitalist told him to go back through the ER.

Sep 21, '17

Oh, in hindsight we all could have handled the situation better.

I'm impressed with your self examination and admire you for being open to responses and criticism, NurseMom.

Welcome to AN.com! Glad to know you as a Peer!

Sep 21, '17

Sure you could have handled the situation better. But honestly, I think you did a pretty good job!

As several other posters stated, I would have given the guy the coffee after educating him as to why he was on fluid restrictions. I would have documented this, and probably called the MD. Then MD can then decide what they want to do with their patient.

This patient had a long history of non-compliance. They will continue to be non-compliant. Nothing will change.

You did the best you could while being verbally and physically abused. The comment about malpractice insurance is WAY over the top in my opinion. Not every patient is interested in improving their health, or even living.

Sure you could have handled the situation better. But honestly, I think you did a pretty good job!

As several other posters stated, I would have given the guy the coffee after educating him as to why he was on fluid restrictions. I would have documented this, and probably called the MD. Then MD can then decide what they want to do with their patient.

This patient had a long history of non-compliance. They will continue to be non-compliant. Nothing will change.

You did the best you could while being verbally and physically abused. The comment about malpractice insurance is WAY over the top in my opinion. Not every patient is interested in improving their health, or even living.

I agree. I'm surprised the OP isn't receiving more support from us, fellow nurses. I understand you have to pick your battles, but under the circumstances, this kind of patient to nurse abuse is not acceptable.

Give me a break. Nurse has no right to refuse to do a lot of things, but running to get coffee for someone who just became abusive is not one of them. I don't think the nurse was wrong at all for trying to have a conversation and to double check things. Patient had NO RIGHT to become abusive, and once he did, the dynamics totally change. I'm glad he left.

(Just to add -I am not a coffee drinker, and I do get that some people really do love their coffee!)

Last edit by NightOwl0624 on Sep 21, '17
: Reason: Spelling mistake

Sep 21, '17

I have to respectfully disagree with the ones saying to just bring him the coffee. At the hospital I worked at if we would've gone against doctors orders of a fluid restriction we would've been in deep doo-doo. The fluid restriction is a doctors order. It would've been comparable to the MD ordering one Lortab and the patient saying, no, give me two. And throwing a FIT like a child until someone gave in to his request.

Yes, you educate. But in the world we live in, even documenting we did teaching sometimes isn't good enough if the patient ends up in fluid overload and then says "Well Nurse Jane just kept bringing me coffee every time I asked for it!"

Not only that, but you doing your job caused him to throw water at you. Unacceptable. You're lucky it wasn't the hot coffee.

What I probably would've done is called the doc and told him he was becoming belligerent and asked if the doctor wanted me to give him the dang coffee. Most docs I work with would've said no, they don't tolerate their nurses being verbally abused and let him go on his merry way.

ETA:If the fella wanted to have a friend bring him a drink, that's one thing. We can educate and then document what we see. But if WE are the one's bringing him a drink, that's a problem. We aren't following orders, plain and simple.

Give me a break. Nurse has no right to refuse to do a lot of things, but running to get coffee for someone who just became abusive is not one of them. I don't think the nurse was wrong at all for trying to have a conversation and to double check things. Patient had NO RIGHT to become abusive, and once he did, the dynamics totally change. I'm glad he left.

(Just to add -I am not a coffee drinker, and I do get that some people really do love their coffee!)

Feel free to take a break.

Use your assessment skills to look at the big picture. This is not about serving a patient a cup of coffee. This is about managing a patient that is declining doctor's orders.

Certainly, an alert and oriented patient does not have the right to abuse a nurse. The POINT is the nurse escalated the event.

"I'm glad he left." Why is that? So the nurse no longer has to deal with a mis-managed patient.. that is clearly unable to be discharged.. and asked to stay? You won't be so "glad" if he comes back in fulminating pulmonary edema and it was YOUR name on the discharge.

Use your assessment skills to look at the big picture. This is not about serving a patient a cup of coffee. This is about managing a patient that is declining doctor's orders.

Certainly, an alert and oriented patient does not have the right to abuse a nurse. The POINT is the nurse escalated the event.

"I'm glad he left." Why is that? So the nurse no longer has to deal with a mis-managed patient.. that is clearly unable to be discharged.. and asked to stay? You won't be so "glad" if he comes back in fulminating pulmonary edema and it was YOUR name on the discharge.

I'm going to go against the tide here. I've been in the OP's position, I discharged the patient and I re-admitted him ten hours later when the ER sent him back to our unit after he binged on a large pizza and a 12 pack. I have to say, he was far more cooperative the second time around -- seems like maybe the physician was right about the fluid restriction in the first place. Even though it was my name on the discharge, and even with at least 20 years of 20/20 hindsight, I still have no regrets.

So, then I go to the room. He politely asked for coffee. I politely said back, "ok, let me check the chart and see how much fluid you are at so far because you are on a restriction." This sets him off. He shoves his bedside table towards me, knocking off some of the remnants from his breakfast tray towards me. He begins to curse at me, saying things like "you stupid f***ing nurse" being the primary phrase. So, I calmly say "there is no reason to be this way to me, to be cursing at me. I will come back after you calm down." So I leave and close the door, and he is still cursing.

Please explain how the nurse acted to escalate this?

Once he changed his mind after he was discharged and iv and foley were removed, he could have gone back to the ER.

Alert and oriented people are responsible for their actions.

Sep 21, '17

Time to get your charge RN/DON/floor supervisor involved with all of the aspects of this situation that made you uncomfortable. Do you have a debriefing process in place for difficult situations like this? I would also invite your coworkers so everyone could get on the same page about policy.

1) What is the FR policy at your facility? Get everyone on board. If the doctor is going to bring in coffee when he is over his FR, what is your obligation? I would emphasize the MD brought him coffee, since this is who you would notify anyway. Get a hard line policy in place for the unit. Is it adhere no matter what, or educate, document, notify?

2) What is the policy for patients who have been discharged and then decide to stay? If another situation arises, what is the facility expectation? Notify MD and put a hold on discharge? Or direct patient to ED?

Some of the best advice I have ever gotten is 1) never get into a power struggle with a patient and 2) do not let the need for a patient to "like" you affect your duties as a nurse.